COUN 580: Concepts of Chemical Dependency: Chapter 5

vitamin deficiency amblyopia

blurred vision, a loss of visual perception in the center of the visual field, and in extreme cases atrophy of the optic nerve, all of which may become permanent

scientists have discovered a degree of __________ size reduction in heavy drinkers

brain

free radicals

molecules that, because of their ionic change, are able to attach to and damage other molecules, thus disrupting the normal function of cells and possibly contributing to cellular death. often contain an extra oxygen molecule which will then bind to molecules found in cell walls, causing damage

chronic alcohol use & medication abuse

more likely to abuse prescription drugs 25-50% of alcohol-dependent ppl also addicted to benzos can lead to fatal overdose

psychological dependence

needs alcohol to relax, have sex, sleep, cope w/ stress, etc. (fulfill psychological needs)

disconnection syndrome

neural connections between neurons are destroyed

as a group, long-term alcohol abusers have been found to demonstrate evidence of impaired _____________________ up to 4 weeks after their last drink

neurological testing

binge drinker

not daily drinker. consumes 5+ cans of beer or standard mixed drinks in a single episode of alcohol consumption

true/false: there is evidence that coffee consumption might reduce individual's risk for developing alcohol-related cirrhosis

true

true/false: majority of ppl w/ an AUD live lives that are successful & productive on the surface

true-- making it difficult to identify heavy drinkers

Neurontin

useful as hypnotic agent in alcohol-dependentt person. lacks abuse potential.

Tardive dyskinesia (TD)

usually develops after 10-20 years of heavy alcohol drinking

Alcohol abusers are predominantly ______

male

intensity of AWS depends on

-duration and severity of use -overall state of health -possible concurrent SUDs severe cases can be life-threatening

alcohol use disorder (AUD) criteria used to be that the person

-require the alcohol to function -make attempts to limit their heavy alcohol use to a specific time (weekends, for example), w. periods in between episodes of heavy use -engage in continuous "binges" that last for days, weeks, or months, interspaced with periods of abstinence or -engage in daily use of alcohol in excess of social norms/ health

AWS can be mistaken for conditions such as

-subdural hematoma -pneumonia -meningitis -infection involving the CNS *unless the physician was aware of drinking history

Effects of Alcohol on the Chronic Drinker based on Blood Alcohol Level (BAL)

0.05-0.09- none to minimal 0.10-0.19-mild ataxia, euphoria 0.20-0.29-mild emotional changes, ataxia more severe 0.30-0.39- drowsiness, lethargy, stupor 0.40-0.49-coma. possible death. 0.50-0.60-resp. paralysis maybe resulting in death

typical alcohol-dependent person in US will experience first psych. or medical problem as a result of their drinking / enter treatment for first time at what ages

20s-30s (first psych/med problem) 40s (treatment)

severe AWS

8-12 hours after last drink may get extended to 10 days after last drink sx. can be same as milder sx. but also hallucinations, hypothermia, sepsis, and cardiac arrhythmias. alcoholic hallucinxsis if hallucinations during WD (usually 1-2 days after last drink-- usually auditory - voices that are accusatory, threatening, or critical of past/current behavior). sometimes ppl respond to hallucinations

alcohol use and the DSM

5 subforms of lac-related disorders: alcohol use disorder alcohol intoxication alcohol withdrawal other alcohol-induced disorders unspecified alcohol-related disorder diag. criteria for AUD includes cultural & gender factors, but are essentially same to assess dependence -- tolerance, failed attempts to quit, craving modifiers - actively drinking, remission, controlled environment (drinking curtailed) other alcohol-included disorders - alcohol induced conditions which stimulate other forms of psychopathology such as a psychotic reaction. usually resolved soon after withdrawal

Anti-diuretic hormone (ADH)

A hormone produced by the pituitary gland when the body is dehydrated. It causes the kidneys to reabsorb more water into the blood making the urine more concentrated. alcohol inhibits the release of this increases risk for Cardiovascular & neurological damage

cirrhosis of the liver

A severe medical condition where scar tissue in the liver replaces functional tissue. body can become unable to cleanse itself and will eventually die related problems - sodium & water retention, problems that indirectly affect cardiac function.

delirium tremens (DTs)

A severe withdrawal syndrome seen in alcoholics who are deprived of ethyl alcohol; characterized by restlessness, fever, sweating, disorientation, agitation, and seizures; can be fatal if untreated.

effects on CNS

CNS often 1st organ to demonstrate evidence of alcohol-related damage - may reflect factors such as amt. of alcohol consumed over lifespan, pattern of ingestion, frequency & intensity of withdrawal episodes, genetic heritage. evidence of memory deficits even after one drink gaps in memory - blackout

severity of the alcohol withdrawal often assessed with the

Clinical Institute Withdrawal Assessment for Alcohol Scale Revised measures 15 sx of alcohol withdrawal with each sx being rated in severity for max. score of 67 oiints 0-4 minimal discomfort from AWS 5-12 mild alc. WD 13-19 moderately severe 20+ severe alcohol withdrawal can be repeatedly administered, marking improvement or deterioration over time. co-existing conditions (anxiety etc.) can inflate the score Doesn't include vital signs as criteria

esophagel varicies

high pressure levels can cause blood vessels in esophagus to swell & become weak; may rupture w/ little warning -- 20-30% death rate

vitamin malabsorption syndrome

Habitual drinkers are known to have trouble absorbing Vitamin A, D, & B family of vitamins & minerals such as calcium, sodium, phosphorous & magnesium

alcohol-dependent ppl are at increased risk for contracting the _____________ virus

Hep C

patients with __________ disease tend to abuse alcohol more often than those who do not have this condition

Huntington's disease alcohol suppresses some of the involuntary movements of this disease

the abuse of alcohol contributes to a # of metabolic disorders such as

Type 2 Diabetes. a lot of drinkers are diabetic or glucose-intolerant, conditions that reflect lac-related interference w/ body's normal glucose control mechanisms

Alcohol Withdrawal Syndrome

acute phase - 5-10 hours after last drink. proof by health care workers that person is phys. dependent on alcohol.

mild alcohol withdrawal

agitation, anxiety, tremor, diarrhea, abdominal discomfort, exaggerated reflexes, insomnia, vivid dreams, nightmares, vomiting, tachycardia, headache, memory impairment, concentration problems, possible WD seizures begin 16-24 hours after last drink and in mild cases usually subside after 48-72 hours

korsakoff's syndrome

an alcohol related disorder marked by extreme confusion, memory impairment, and other neurological symptoms Wernicke's is the acute stage and Korsakoff's is the end stage of thiamine depletion at least 10% of ppl. w/ W-K are left with permanent memory impairment unable to retain new info, but can recall events from his/her distant pass may have memories that never took place (confabulation) extreme cases- frozen in time

young adult alcoholics (31.5%)

average age of onset- 20 years; low rates of other drug abuse & mental illness, 1/3 still in higher ed

intermediate familial alcoholic (18.80%)

average age of onset- 32; familial history of AUDs in many cases. high levels of depression/bipolar affective disorders. drug use disorders often present.

young antisocial alcoholics (21.10%)

average age of onset-21.1; some familial history of AUDs, high rates of MH probs & drug abuse

functional alcoholic (19.40%)

average age of onset-37; well educated, usually w/ state jobs & families. limited history of AUDs in family of origin. moderate rates of depression

chronic severe alcoholic (9.20%)

average age-29. frequent history of familial AUDs; high rates of MH issues& other SUDs

respiratory system

cause & exacerbate sleep apnea increased risk for aspiration pneumonia & other forms of respiration failure chronic alc. use alters natural defense mechanisms from the mouth down to the alveolar spaces in the lungs, in part by reducing the effectiveness of the macrophages guarding the lungs

glossitis

change in the bacterial growth pattern in the mouth

individua's alcohol use pattern doesn't remain stable over the course of their life but will __________ as a result of ___________ & ___________ factors

change; internal; external

health care professionals accept that physical dependency on alcohol is produced by

consumption of 16 ounces of 80-100 "proof" liquor or 11-15 12-oz cans of beer, each day for 2-3 weeks -- as a result of this level of alcohol intake, the body will have attempted to compensate for the alcohol during and upon stopping or significant reduction of alcohol intake, the compensatory mechanisms will then cause a characteristic alcohol withdrawal syndrome.

other body systems

decreased libido reduced vag lubrication period irregularities decreased sperm production count, impotence profound effects for fetus calcium loss increase chances of injury/death TBIs in most cases the AUD preceded the TB cancer development -- breast & colon interferes w/ normal immune system function

emotions affected

depression - 40% of those with AUD 4-fold increase incidence of depression anxiety in 80% of patients going through withdrawal withdrawal symptoms similar to sx. of GAD strong history of suicide and AUDs alcohol-related suicides likely occur in middle to late adulthood alcohol has ability to affect dopamine turnover tin the brain

Cerebellar atrophy syndrome

developed by 1% of heavy drinkers; symptoms include characteristic psychomotor dysfunction, gait disturbance, and problems coordinating muscle movements

paradoxical rage reaction

develops after patient has ingested a CNS depressant, not a stimulant *unsure if this exists

effects of chronic alcohol use on digestive system

distillation - many of the vitamins, minerals & amino acids found in original wine are lost, limiting drinker's ability to get these body loses some ability to absorb needed nutrients from food that is ingested, adding to the depletion of vitamin & mineral reservoirs in the body alcohol biotrans. results in formation of carbohydrates, leading to "empty calories" - drinker feels satisfied & not hungry ability to absorb nutrients blocked by alcohol alcohol-induced diarrhea interferes w/ body's ability to absorb necessary nutrients from food, leading to malnutrition. if vitamin deficient, they develop avitaminosis. inflammation of the pancreas (pancreatitis) from exposure of pancreatic cells to alcohol. about 10% of heavy drinkers eventually develop this disorder.

early stage of AWS

drinking upon waking

scope of the problem

each year an estimated 2.4 million ppl around the world die from lac-related illness/injuries (approx. half of that of tobacco-related illness), making alcohol use/abuse a factor in 3.8% of all deaths & 4.6% of all cases of disability around the world each year Europeans consume most alcohol in the world US- 90% of all adults will consume alcohol at some point 65% of adults are current alcohol users more than 60% of adults in the US drank to the point of intoxication in past years depending on criteria used, perhaps 10-20% of adults who drink will ever meet diagnostic criteria for an AUD

chronic ingestion of alcohol can also induce damage to the __________ cells lining the ____________, allowing certain toxins produced by gram-negative bacteria to enter circulation more easily. This is also known as ____________syndrome

endothelial; intestines; leaky gut syndrome

50-70% of habitual drinkers demonstrate _____________________ in the brain

enlarged ventricles

risks for development of DTs

existence of concurrent infections (pneumonia) during WD process tachycardia signs of autonomic nervous system over-activitity in spite of an alcohol concentration at/above one gram per liter of body fluid history of previous epilepsy history of previously experienced the DTs

person w/ an AUD typically will

experience any of a wide range of medical, social, legal, or vocational consequences as a result of drinking may continue to use alcohol despite awareness of consequences may have attempted to cut back or control use formal diagnosis made on basis of diagnostic criteria in DSM

alcohol-induced blackout

form of anterograde amnesia induced by alcohol's ability to disrupt action of GABA & NMDA in the brain.

AUD definition -

includes wide variety of drinking behaviors; common element - abusive use of alcohol to the point where they experience various psychosocial/vocational/medical problems as a result of drinking and possibly to the point where they're dependent on it

portal hypertension

increase in blood pressure as heart struggles to maintain circulation

other risks of chronic use

increase risk for developing various forms of cancer -- oral cavity, pharynx, liver, stomach, colon, rectum, breast, esophagus dangerous to smoke also 38-fold higher risk of cancer of the mouth or pharynx if also a smoker *mouth or throat risk reduced after 5 years of abstinence and at the end of 20 years - virtually the same as that of a person who never had an AUD

effects on use on circulatory system

increase risk of coronary heart diseases by as much as 600% exacerbate hypertension & induce an increase risk of stroke alcohol increases blood levels of angiotensin II, a compound among other things causing blood vessels to constrict can damage muscle tissues of body. alcohol is said to be cardiotoxic. inhibits synthesis of proteins in the muscles development of early onset cardiovascular disease & undetected clinical cardiomyopathy is thought to be present in 25-40% of chronic drinkers. 40-80% w/ disease will die within 4 years of dx. if drinking continues

REM Rebound

individual experiences longer, more intense REM dreams. often difficult for newly abstinent drinker to separate from reality and can serve as relapse trigger for former drinker because of intensity. Can continue for up to 6 mos. following last drink drugs used to treat anxiety or insomnia have high abuse potential -- leading to cross addiction risk

physical dependence

individual suddenly stops drinking & develops alcohol withdrawal syndrome (AWS). begin to crave it and seek it in other forms (mouth wash, sanitizer)

gastritis

inflammation of the stomach

effects on liver

interferes with the production of the enzyme glutathione between 80-90% of heavy drinkers will develop early manifestation of liver disease ("fatty liver" or steatosis)- enlarged liver that doesn't function normally & can develop just after a few days of heavy drinking. persistent drinkers who manifest this and continue to drink can experience alcoholic hepatitis -- an extension of steatosis w/ additional sx. of liver inflammation, pain, death of liver cells & dev. of collagen deposits in the liver.

complications of chronic use

lose up to 25 years of potential life compared to nondrinkers alcohol-related organ damage places a strain on health care system. there is a dose-dependent relationship between amt. ingested by individual in both frequency & length of stay in hospitals greater # of health problems can be influenced by genetics

tremor

often one of the first withdrawal signs often self medicated with alcohol

peripheral neuropathy

one of the most common manifestations of alcohol-induced nervous system. feelings of weakness, pain, burning sensation in affected region of body at time of onset, followed by loss of sensation in peripheral regions of the body. major factor likely to be depletion of B family vitamins

alcohol & dementia theories

one theory holds that alcohol-related dementia is the direct result of alcohol's toxic effects on the brain. 2nd theory - alcohol induced vitamin deficiencies are the direct causal mechanism 3rd theory - alcohol-induced liver damage result in the brain being chronically exposed to toxins normally filtered from the blood, resulting in neuronal loss

other areas of the brain that can be affected

prefrontal context, cerebellum

chronic alcohol use can contribute to long-term _____________

psychomotor coordination problems

tolerance

reflects individual's drinking history & genetic inheritance can decrease over time because of aging and the accumulated damage to the liver

effects on sleep cycle

require more time to fall asleep less sound sleep and less restful insomnia common alcohol's ability to suppress production of melatonin in brain (which is involved in maintaining the sleep/wake cycle) heavy drinkers can overestimate amount of time necessary to fall asleep, gives impression of sleep disorder present suppresses REM sleep, can interfere w/ cognitive functioning during waking hours.

Extended Alcohol Withdrawal

some sx. of the acute phase continue (anxiety, sleep probes, neuropathies) might last for 3-12 months after lsat drink depression, emotional excitability, fatigue, emotional volatility use cues that might trigger a return to active drinking -- stimuli etc smell of cigarette smoke alcohol use interspaced with withdrawal enhances withdrawal, adding to motivation to continue drinking

alcohol use can cause or exacerbate formation of

stomach ulcers -- can cause bleeding

Barrett's esophagus

stricture of the esophagus develops after esophageal tissues have repeatedly been exposed to digestive juices during gastric reflux, as well as a possible traumatic rupture of the esophagus

wernicke-korsakoff's disease

symptoms: ataxia, mental status changes, nystagmus or ocular changes neurological disorder seen in chronic drinkers 19% dont demonstrate any of these symptoms frequently not dx'd until postmortem examination of the body. can be caused by other conditions thought to be caused by thiamine depletion from the body signs of Wernicke's encephalopathy begin to manifest in 1st few hours/days after use of alcohol is discontinued by the heary drinker. this is the period in which they're more likely to experience AWS, making dx. difficult. treated by automatic intramuscular injections of thiamin

the period of greatest risk for withdrawal related seizures begins

within 244 hours after last drink peaks 48-96 hours after that time 60% of the time, will have multiple

subtypes of alcoholism:

young adult young antisocial functional intermediate familial chronic severe